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J Trop Med Hyg. 1995 Feb;98(1):29-34.

Treatment of malaria outside the formal health services.

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1
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.

Abstract

Self-medication for malaria is widely practised around the world, and although many home treatment episodes are successful, the risk of under or over-dosing is always present. Reasons for the widespread use of self-medication range from the distance and cost of seeking care from the formal health services to cultural beliefs which suggest that traditional care is more appropriate, and even that modern care may be fatal. But self-medication constitutes an important resource for malaria treatment, and much could be done to improve the self-medication practices of the population. Measures to be taken include dissemination of clear messages about malaria as a part of health education, formulation of realistic treatment policies which take account of resource constraints, lowering or removal of economic barriers, especially user charges, and further research into cultural beliefs about malaria and ways to promote compatibility of beliefs with appropriate treatment. If these suggestions could be taken into account in developing malaria treatment strategies, the chances of success would be greatly enhanced.

PIP:

Home treatment of malaria is the norm in many developing countries, with chloroquine the most widely used drug for self care. Treatment in formal health services occurs mainly in very severe cases or when services are accessible. Inappropriate treatment policies explain, in some cases, why persons forego formal malaria treatment. A malaria treatment policy in the Philippines required microscopic diagnosis for antimalarial treatment, yet, six weeks could pass between first visit and confirmation of positive blood smear for persons in remote rural areas. People with malaria self-medicate because it is more convenient, easy, less costly, and saves more time than formal treatment. Also health workers do not always make sure that patients clearly understand instructions. Patients often feel that health workers are too busy and may become impatient if they ask for clarification. User charges for services and/or drugs, becoming increasingly more common in developing countries, pose an economic barrier to antimalaria treatment at formal health services. In Ashanti-Akim district in Ghana, user charges reduced use of health facilities but the quantities of drugs supplied stayed the same, resulting in a high wastage of antimalarial drugs. Beliefs about malaria also hinder use of antimalarials. On the Kenyan coast, severe complications of malaria (e.g., convulsions, splenomegaly, and anemia) are believed to be completely different diseases and to have no connection with malaria. Each complication is treated differently, not with antimalarials. Incorrect dosage and delay in seeking care in severe cases are the leading disadvantages of self-treatment. It would be productive and realistic to identify ways to channel resources into more appropriate ways of self-medication. To do so, one must have a simple, clear message and disseminate it in appropriate ways. Realistic treatment policies and more research in people's traditional beliefs about malaria are also needed. Economic barriers should be dismantled.

PMID:
7861477
[Indexed for MEDLINE]
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